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PRACTICE MATTERSby: Sarah Lynn Lovell Frey, MD During my third year of residency training at the University of California, Irvine, a group of new physicians joined the university and formed an OB/GYN Hospitalist division within the department of Obstetrics and Gynecology. Throughout my residency training we worked closely with all the attending physicians on the labor and delivery unit. However, this new group of physicians was unique – they specialized in hospitalist obstetrics and gynecology. In addition to benefiting from their knowledge, experience, and teaching on labor and delivery, the unit soon was benefitting directly from their unique approach through in situ simulation drills, updated hemorrhage protocols, and new safety tools developed with Perinatal TeamSTEPPS – a Lifewings Hardwired Safety Committee. While searching for my own post-residency plan, I had many insightful conversations with Dr. Jennifer Butler, the director of the OB/GYN Hospitalist Division. We discussed a myriad of career paths. During this time it also happened that the division was initiating a new fellowship program for OB/GYN hospitalists. When I heard about this fellowship opportunity I was instantly intrigued. With a focus on becoming a leader in hospitalist safety and implementation, I applied to the fellowship and was excited to be accepted as the first participant in the OB/GYN Hospitalist Fellowship at UC Irvine. The fellowship is one year in length, and provides high quality, advanced education in hospital-based obstetrics and gynecology with a focus on maximizing patient safety development of skills to become a leader in hospitalist medicine in both academic and community-based hospital settings. At Fountain Valley Regional Medical Center, a local community-based hospital, I worked alongside the OB/GYN hospitalist team on the labor and delivery ward, providing immediate emergency obstetric care to patients as needed and supporting other community OB/GYN physicians during massive hemorrhage situations. Several times per month I also worked with the perinatology physicians in the ultrasound suite, improving my ultrasound skills. I also participated in a variety of activities focused on improving safety, education, and communication on the labor unit. In the OB Quality Core Committee meeting, nurses and physicians worked alongside anesthesiologists, neonatologists, and hospital administration to address concerns on the unit ranging from induction of labor, postpartum hemorrhage rapid transfusion protocols, and streamlining antibiotic administration and a team-based approach to chorioamnionitis management. A specific project I was assigned to was an initiative to reduce the episiotomy rate on the unit through increased awareness and education of providers. Working with the incredible nursing staff in the labor unit through regular fetal heart rate tracing rounds, nursing education lectures, nursing skills day activities, and as a team in emergency situations both simulated and very real was a true highlight." At UC Irvine Medical Center, I supervised and taught resident physicians on a busy high-risk labor and delivery unit, while also providing emergency room gynecologic consultations. Throughout these shifts an OB/GYN Hospitalist attending was assigned as back-up, available for phone curbsides and to assist in person to ensure maximum patient safety in the event of an overwhelmingly busy unit. Twice per month I gained interdisciplinary knowledge and experience by joining the anesthesia team, learning to place epidural and spinal anesthesia to our laboring and cesarean section patients, evaluating patients with a post-epidural headache, and assisting with arterial line placement and blood transfusions with the anesthesia team during complicated cases of placenta accreta necessitating a cesarean hysterectomy. In addition to the incredible clinical experience, I was able to gain further gynecologic surgical experience through advanced dilation and curettage and dilation and evacuation training at Planned Parenthood, staffing resident clinic gynecologic cases, and assisting the gynecology oncology attending physicians in the operating room when needed. Most importantly, the OB Hospitalist fellowship provided me with incredible opportunities to work with wonderful nurses, scrub technicians, clerks, and physicians from a variety of disciplines to improve safety for patients and staff both on the labor and delivery unit and throughout the hospital. As a year-long research project, I worked with the OB Perinatal Simulation team to design and implement a study assessing the educational impact of multidisciplinary simulation training versus lectures in obstetric emergencies. The findings resulted in expansion of the multidisciplinary training, especially amongst the physician and nursing staff. These findings and were presented at this past year's Society of OB/GYN Hospitalists Annual Clinical Meeting and the Society for Simulation in Healthcare’s International Meeting on Simulation in Healthcare. As a member of both the Perinatal TeamSTEPPS and Quality and Safety Committee, I gained knowledge regarding the challenges facing the nursing, OB/GYN, anesthesia, and neonatal teams. I was introduced to the quality indicators by which the hospital is monitored, and I was able to contribute to implementation of a monthly multidisciplinary electronic update to facilitate communication of new recommendations and safety measures in the department. I also participated in medical education through medical student simulation lab, cadaver lab teaching, and by providing teaching lectures to medical students, OB/GYN residents, Family Medicine residents, and Surgical ICU residents, fellows, and attending physicians. Throughout the year I had the support and encouragement of five incredible OB/GYN Hospitalist attending physicians who were available and eager to discuss project ideas, answer questions, provide a sounding board on several projects, and edit more papers and IRB submissions than I ever thought possible. After completing the one-year fellowship, I have had the opportunity to apply the skills gained to my current role as a lecturer and faculty member at Busitema University Faculty of Health Sciences and Mbale Regional Referral Hospital in Mbale, Uganda through the Global Health Service Partnership, encompassing Peace Corps, SEED Global Health, and PEPFAR. Although the setting and resources are starkly different than those in the United States, with a maternal death rate of 343/100,000 births according to the United Nations Population Fund, the principles of safety remain the same. I have had the opportunity to teach medical students, interns, medical officers, and even colleagues about uterine balloon tamponade for postpartum hemorrhage, fluid management in severe pre-eclampsia and eclampsia and even taught by example the role of perimortem cesarean section during a maternal code. I am incredibly thankful to the OB/GYN Hospitalist Division and the entire UC Irvine Perinatal Team of nurses, physicians, and staff for the dedication and teaching they provided me during the year. Words cannot even begin to express my gratitude. Sarah Lynn Lovell Frey, MD FACOG |
